A Study on Physical, Social and Mental Problems of the Elderly in District 13 of Tehran

Ali Reza Kaldi
Associate Professor
University of Social Welfare & Rehabilitation Sciences
Evin, Tehran 19834, IRAN

Phone: (+9821) 2418753
Fax: (+9821 2418753
Email: arkaldi@yahoo.com

ABSTRACT

Introduction: According to statistics, 6.6 percent of the total population of Iran, about 4.6 million persons, are included in the age group of 60 and over. The total number of this age group residing in Tehran is about half a million.

Objective: This research was conducted to distinguish the physical, social and mental problems of the elderly in Tehran.

Methodology: The method of this study is based on survey research. Data was collected by questionnaire, from residents of District 13 in Tehran. To do so, random sampling has been used to select a sample of 300 persons who come to the elderly cultural center, Hafezieh cultural center, and Pirouzi park in district 13 in Tehran. Data was analyzed by SPSS.

Results: According to this research, from 300 people, aged 60 and over (52 percent women), 32.3 percent of the sample were illiterate, and 3 percent were single. 55 percent of the respondents had economic problems, 25.6 percent had difficulties in current living conditions of daily life, 21 percent expressed dissatisfaction with their current living conditions, 27.3 percent did not have medical insurance. 24 percent of the respondents had moral and emotional problems, such as depression, anxiety boredom and need for counseling.

Conclusion: The elderly people in Tehran, particularly women, face multiple problems, including economic, physical, social, mental and emotional issues. These problems influence the quality of life of elderly people. This study shows that a more accurate social welfare program for the elderly is vital, to provide a better and fullfilling life.

Key Words: Physical problems, Social problems, Mental problems, Elderly, Iran

Introduction

Considerable progress in medical science, upgrading of health levels and life facilities, and decreases in infant mortality, lead to a rise in the average life expectancy of human beings. Today, in some developed countries the life expectancy average has reached over 85 years. According to the latest official statistics, the life expectancy average in Iran has reached 67 years and based on the 1996 statistics, the population of over 60 year olds in Iran is more than 4 million people.  In populated cities, especially in Tehran, due to the high costs of life and housing, results in people working full time and spending most of the time out of the house and this leads to a smaller space for living and less leisure time; hence families become smaller. 

It seems that the elderly are considered as the vulnerable group in the society because of their weakness and decrease in capabilities. Therefore, they need to be studied and supported and their physical, social and mental requirements should be evaluated. Thus, this study has been performed in order to search out some information regarding the physical, social and mental problems of the elderly and to study the proper solutions to solve these problems.

The elderly are a group of society that in the contemporary world, along with the huge progress of industry, science and technology are considered as a growing population with specific needs and the governments obliged themselves to pay more attention to the life quality of this group. Nowadays, in the industrialised world, enormous investment are made for the needs of the elderly, such as treatment, rehabilitation, proper nutrition and leisure time. In this regard, developing countries are facing huge problems in rendering the above mentioned services to this group of society. These countries have neither a public budget for providing various services to this group, nor the capability to respond to their basic needs.

Illness, incapability, mental disorders, death of spouse, poverty and many other social factors cause the elderly to have different needs from the other groups of society. It is important to pay attention to them.

Objectives

The objective of the study is to give a clear image of physical, mental and social needs of the elderly. Moreover, to recognize the present status of the physical, mental and social problems of the aged and to provide a proper solution to promote elderly life quality, is another aim of the study. Hence, by knowing the precise needs, it is easier to take basic actions on meeting the essential needs of the aged people concerning their treatment, rehabilitation, nutrition and leisure time. 

Theoretical Principles

According to the 1996 census, the number of the elderly over 60 years old in Iran is about 6.6 percentage of the whole population. In separate studies on physical, mental and social problems, these three problems have never been seen in consort. For instance, in a study on aged women’s problems, it was shown that economical problems of women are greater than men’s or illiteracy among aged women is more than among aged men. In addition, it is shown that women are less prepared for an independent life compared to men. Also, prevalence of disease and functional limitations are higher among women. The data therefore shows the necessity of concentration on problems of the elderly and the need for proper solutions.

Aging from a medical point of view. Aging is a life cycle that includes all the living creatures including human beings. Aging phenomena is not a disease but it is a vital event that embraces everybody and in fact it is a natural process in which physiological and mental changes of the body occur.

From a geriatrics view point, aging is the result of a slow biologic and physiologic process with apparent symptoms which include hair whitening, skin wrinkles and creases, presbypia, poor hearing, dawdling movements,  curvature, muscle weakness, respiratory problems and so on.

Although aging is not a pathologic symptom (disease), it limits physical and mental activities and it impacts on physical, mental, cultural, social and economical activities of a person.

There are different theories about aging mechanisms which sometimes vary. In spite of ambiguity in biologic changes, physiologic developments are clearer. Generally, physiologic changes occur because of decrease of the functional capacity of organs. The decrease of functional capacity of organs starts in the third decade of life. It happens progressively and gradually; of course, its speed differs in different people.

Body composition includes four essential parts: Bone, active mass of cell, fat, water. In the aged, increases in these elements are affected by various means. Although changes differ from one person to another, a common pattern in this regard causes a similar change in the four above said elements in all old people.

We can outline a few changes depending on age and its subsequent diseases, as follows: 1-Hypertension, 2- Cardiac disease, 3- Brain stroke, 4- Diabetes, 5- Cancers, 6- Respiratory diseases, 7- Incontinence, 8- Vision and hearing disorders, 9- Mental disorders, 10- Traumas, 11- Mouth and teeth problems.

Aging from a social point of view: Roles and value of the elderly differ a lot in different societies. It seems that in traditional societies, and old person is respected while he can participate in cultural, economical and social affairs of society using his metal and physical powers. In developed countries aging is often interpreted as illness, with the elderly seen as useless and dependent. Theoreticians in these societies believe that the old afe after retirement, becomes a burden on government funded aged care facilities as the aged are no longer contributing to society in economic or other terms. The importance of the aged in society, therefore is underestimated.

In China, unlike western countries, aging is not considered as a mental decline. In intellectual tests, old Chinese get a better score compared to Americans of the same age.  Some people believe this difference exists because of cultural customs. In the first group, aging is a valuable event and the elderly are respected and seen as wise, which is the exact opposite, in the west.

However, having a full understanding of the aging process needs a thorough and correct knowledge about the future of different branches in the life process. Biologic conditions of life, involves the human being in the interpretations that have been made in different cultures and during various eras of the human being’s history. Social identity of a person can be shaped via parental beliefs and opinions about their child. By passing away and spoiling the body, personal identity will be eliminated, but social identity can remain for a long time. Due to the changes in the age structure of the Iranian population, aged populations will become more perceptible in coming decades.

According to the latest data from the information center of the registration organization in Iran, 58% of the elderly are covered by different insurances of which 36.7% are covered by a social security organization.

Published statistics via the technical and budgeting deputy of the social security organization shows that the growth in the number of the retired is much quicker than growth in the number of insured people. So that in a ten year period from 1984 to 1994, numbers of insured people has become double and retired persons become triple. Obviously, problems of the growth rate of the aged percentage of the population, will be strongly reinforced and its financial burden will increase too.

So far, many countries have performed essential modifications regarding different fields of insurance for the elderly, such as retirement and medical services. Implementing these policies during recent years has encouraged personal prudence plans, especially, through retirement and private savings. Those people who have the necessary means to look after themselves, can manage without depending on state assistance. In many countries, implementing social assistance and ensuring the whole society, including the elderly receive social services,  is the most important goal.

Methodology

This study uses a documentary and measurement method. Measurement means to collect data that can be used as a practical guide to describe or anticipate relationship analysis between some variants, like cancer and cigarettes. Measurement usually takes place on a large scale which is the opposite of laboratory analysis, which usually takes place on a smaller scale. Data required is collected via questionnaire, interview and other proper methods. For the experiences in a small volume, the above said cases can be used (Openheim, 1996:9).

Population is the completion of the units which are common in some issues and in this study the population units are people over 60 years old residing in Tehran, district 13. The statistical community is 4,811 people.

Each population unit, which is selected as a member of sample, is called one selected unit or sample unit. This unit can be a person or a final unit or a group of assembled people, or a so-called cluster (Saraie 1996:6). Analysis unit (Statistical unit) is selected based on the dependant variant that we will explain later (Houman, 1994:167).

Statistical unit of the study is the elderly going to Salmand (elderly) cultural center, Hafezieh Cultural center and Pirouzi Park. Each person is considered a personal unit.

Considering the statistics of the elderly referring to Salmand cultural center, Hafezieh Center, Pirouzi Park, the accessible sample was selected in September 2003 among the referees to the above said centers. That is, a total of 300 aged people, over 60 years old.

Aging is the gradual dysfunction of organs which happens, not because of illness or accidents, but over time. Socially speaking, aging is a period of life when the person isnot able to continue living on his own, but needs others' help. The elderly requirements are: Physiology (nutrition); Safety and health; a sense of belonging; dignity and respect; mental and spiritual needs of the elderly; physical, social and economical needs.

In un-eventual sampling, instead of counting on the chance factor, the sample is selected with the help of human judgement; the judgement which is the basis of data collection. Therefore, the chance of each population unit participating in the sample, remains unclear and vague (Saraie, 1996, 11).

In the present study, to select the sample units, a simple random sampling has been used. In the simple random sampling, sample units are chosen coincidentally as the sample presents the studied population. In this sampling, each of the statistical members or elements are holding an equal chance for placing in the sample population (Saroukhani, 1995:161).

Variants of the study are age, sex, marital status, educational background, occupation, ethnicity, income and religion, which are considered as the variants related to the specifications of the interviewees. Moreover, variants concerning physical, social and mental problems are studied in this research.

Since the method of the study is measurement, in order to compile necessary data for evaluation of cases, an arranged questionnaire has been used. The questionnaire includes open and closed questions and it contains two parts; status questions and questions for evaluating independent and dependant variants, by applying the questions with double or multiple choices. The questionnaire was composed of thirteen questions related to the personal details of the respondent, thirteen questions concerning physical problems, 19 questions regarding social problems, seven questions about mental problems and the last two questions on comments of the respondents that together make up 54 questions.

Validity means internal adaptation of the evaluation tools and whether the designed tools are able to be repeated or not.

In order to study the validity of tools, experimental execution was applied in small samples including 30 people, then data was collected and questionnaires were filled. Afterward, by studying the coefficient of Cronbakh α, questionnaires were measured and the reached validity was 86% -  that is a high validity.

Furthermore, to study the admissibility via the present admissibility as the sample admissibility and superficial admissibility, first the prepared questionnaire was presented to a few specialists to receive their comments for amendment. Their remarks were used to modify the questionnaire.

After collecting and coding of data, they were analysed via SPSS software.

To analyse the data, Kai Square tests were employed to determine the variants' relations.

Data

In this chapter, general information regarding the specifications of the statistical community is studied in two-dimensional and abundant distribution tables.

Respondents are between 60 to 86 years old and their average age is 67.7.  40.3% are 60-65 years old, 34% are 66-70 years old, 17.7% are 71-75 years old and 8% are over 76 years old.

52% of the respondents are old women and 48% are old men. Additionally, 65% of the respondents are married, 3% single, 30.3% widowed and 1.7% divorced. 32.3% of the respondents are illiterate, 59.7% have below diploma education and 8% have diploma or higher education. 12% of the respondents work and the rest do not work. 50% earn less than 50.000 Toman per month, 47.7% have 51000 and 100000 Toman monthly income, 8.7% earn monthly between 101000 and 150000 Toman and 6% have over 150000 Toman in month and 38.7% did not answer.

As regular referrals to a physician by the elderly, for examination of their health condition is very crucial, 57.7% of the respondents stated that they see a doctor regularly and periodically and 42.3% gave a negative answer.

Table 1 : Frequency distribution of the respondents based on the following clinical problems

Organ Problem	N	%
Brain and Nerves	30	10
Vision	42	14
Hearing	17	5.7
Cardio-vascular	61	20.3
Respiration	17	5.7
Digestion	24	8
Nephro-urethra	46	15.3
Blood	33	11
Arthro-skeletal	73	24.3
Skin	4	1.3
Endocrine glands	22	7.3
Genital organs	21	7
Others	16	5.3

According to the above table, the most frequent problem is arthro-skeletal (24.3%), then cardio-vascular (20.3%), and then nephro-urethral (15.3%).

Falling down is one of the most frequent problems of the elderly. In the over 60 years old, equilibrium will often be a problem and one of the common consequences is falling down. 27% of the respondents said that during the past year, they had problems of falling.

Weight loss can be a problem of the aging. Water of the body decreases gradually and wrinkles and creases appear on the skin. On the other hand, losing appetite and eating less is often seen among elderly populations. Thus, 51% of the respondents stated that their weight had decreased during the past year.

In the aging process, people are faced with organ failure. 59% of the respondents said that they use eye glasses, 5% use hearing-aids, 8.7% use canes or walkers, 66.3% use artificial teeth, 0.3% use a wheelchair.

Table 2 : Frequency distribution of respondents based on life satisfaction

Life Satisfaction	N	%
Yes	228	76
No	63	21
No Answer	9	3
Total	300	100

Responding to this question of whether you are generally satisfied with your life, 76% said yes and 21% gave a negative answer. Not being satisfied with life among the elderly has many reasons, but the most important is economical problems.

The respondents were asked: “How much are you satisfied with your familial relationships?” 18.7% said very much, 24.3%  a lot, 43.7% average, 9.3% a little, 2.7% little.

Table 3 : Frequency distribution of the respondents based on having leisure time, social and sporting activities

Activity		N	%
	Yes	223	74.4
Leisure time	No	76	25.3
	No answer	1	0.3
	Yes	54	18
Social activity	No	233	77.7
	No answer	13	4.3
	Yes	173	57.7
Sporting activity	No	124	41.3
	No answer	3	1

74.4% of the respondents replied that they have leisure time, 18% had social activities, and 57.7% had sporting activities too. Having plans for leisure time, social cooperation and also sporting activities are essential for healthy aging.

Favorite sports of the elderly include jogging, wrestling, walking, mountain climbing, swimming, tennis, shooting, and ping-pong.

Moreover, their favorite social activities are gardening, local mosque activities, local Bassij activities, and charitable affairs, the local cultural center, watering in the municipality and also being active in cultural centers of the elderly.

The respondents were asked: “Do you have insurance?” 72.4% replied that they benefit from retirement, medical … insurance services, however, 27.3% answered in the negative.

This issue should be studied because having no insurance can cause other problems like economic difficulties.

Those who benefit from the insurance, had one of the following insurance policies: Social security, medical insurance, bank, army and military, Emdad committee, Self insurance, life insurance, Dana, Oil company, Martyr foundation, Head officer's center, Municipality insurance.

Table 4 : Frequency distribution of the respondents based on different mental problems

Different Mental Problems		N	%
	No	75	25
	Somehow	144	48
Do you often feel lonely?	Often	79	26.3
	No answer	2	0.7
	No	66	22
	Somehow	145	48.3
Have you become impatient recently?	Often	87	29
	No answer	2	0.7
	No	87	29
	Somehow	128	42.7
Do you become furious a lot?	Often	82	27.3
	No answer	3	1
	No	103	34.3
	Somehow	132	44
Do you feel the life is meaningless for you?	Often	63	21
	No answer	2	0.7
	No	67	22.3
	Somehow	160	53.4
Do you suffer from anxiety and agitation?	Often	72	24
	No answer	1	0.3
	No	90	30
	Somehow	134	44.7
Are you sleepless most of the nights?	Often	75	25
	No answer	1	0.3
	No	62	20.7
	Somehow	152	50.7
Do you feel tired and exhausted most of days?	Often	85	28.3
	No answer	1	0.3

Studying mental problems of the elderly shows that loneliness, impatience, anger, futility, anxiousness and agitation, sleeplessness and tiredness are the most common problems.

26.3% of the respondents stated that they feel loneliness most of the time, 48% to some extent and only 25% do not feel it.

29% of the elderly replied that they have recently become impatient, 48.3% to some extent. 22% gave a negative answer.

27.3% of them answered that they often become angry, 42.7% to some extent and 29% gave negative answer.

In responding to the question about feelings of futility, 21% said thay had them often, 44% to some extent and 34.3% negative answer.

In replying this question “Do you often suffer from anxiety and agitation?”, 24% said often, 53.4% to some extent and 22% gave a negative answer.

Regarding sleepless nights, 25% answered often, 44.7% to some extent and 30% negative answer. 28.3% of the respondents said that they feel tiredness in the day time, 50.7% to some extent and 20.7% gave a negative reply.

Table 5 : Relation of marital status and life satisfaction feeling 

Life Satisfaction Feeling/Marital status	Yes	No	Total
Married	54.6	10	64.6
Single	1.7	1.4	3.1
Widow	22	10.3	32.3
Total	78.4	21.6	100

         P = 0.002              df = 2                X2 = 12.890

As it shows in the previous table concerning the meaningfulness of the relation between two variants of marital status and life satisfaction feeling, X2 value (12.890) situates the same meaningful level of 0.002. In the other words, there is a meaningful relation between the two variants, that is, married people feel more satisfaction in their life compared to unmarried people.

Table 6 : Relation between educational background and life satisfaction feeling

Life Satisfaction Feeling/Educational Background	Yes	No	Total
Illiterate	23.7	8.6	32.3
Under Diploma	49.8	10	59.8
Diploma and Higher	4.8	3.1	7.9
Total	78.4	21.6	100

          P = 0.018                df = 2               X2 = 8.046

Based on the above table, there is a meaningful relationship between educational background and life satisfaction feeling. X2 value with 8.046 at 0.018 level is meaningful and verifies that with a higher educational background of the respondents there is a higher life satisfaction feeling.

About the mental problems, answers to the questions of 46 to 52 were collected. As the choices included three parts: No = 1, Somehow = 2 and Often = 3;  the least score for seven questions is determined at 7 and the highest score is 21. The average score out of the seven above questions is 13.95 with the standard diversion of 3.46. 

An analysis was performed on the one direction variant to study mental problems and marital status. Result of the analysis shows that there is a meaningful difference between mental problems of the answerers according to their marital status. The table below illustrates the result of analysis on one direction variant.

Table 7 : Analysis on variance of the elderly with mental problems and marital status

Changes source	Total squares	Freedom degree	Average of squares	F	Sig.
Inter groups	63.306	2	31.653	2.668	0.071
Inside groups	3476.208	293	11.864
Total	3539.514	295

Conclusion and Comments

Benefits in the health of the elderly result from a proper quality of life in economic, social, health, medical, physical, mental and cultural fields and involving them in the country's development through recalling them to active participation in society as follows: